Can patients with ileus take oral (PO) medications?

From the Guidelines

Patients with ileus should not take oral (PO) medications. Ileus is a condition characterized by decreased or absent intestinal motility, which prevents normal passage of intestinal contents, including medications. When a patient has an ileus, oral medications will not be properly absorbed and may accumulate in the gastrointestinal tract, potentially causing complications when bowel function returns. Some key points to consider in the management of ileus include:

• Minimizing postoperative ileus through a multifaceted approach, including minimally invasive surgery, optimized fluid management, opioid-sparing analgesia, early mobilization, early postoperative food intake, laxative administration, and omission/early removal of nasogastric intubation, as recommended by the ERAS society 1.
• The use of alternative routes of administration, such as intravenous (IV), intramuscular (IM), subcutaneous, rectal, or transdermal, depending on the medication needed and its available formulations.
• For patients requiring pain management, medications like morphine or hydromorphone can be given parenterally.
• Antiemetics such as ondansetron can be administered IV, and electrolyte replacements should be given intravenously as well.
• The underlying ileus should be treated by addressing the cause (such as postoperative recovery, electrolyte abnormalities, or medications), maintaining NPO (nothing by mouth) status, providing IV hydration, and possibly using nasogastric tube decompression.
• Oral medications should only be resumed once there are clear signs of returning bowel function, such as passing flatus, having bowel movements, or decreased abdominal distention. It's also worth noting that some interventions, such as mid-thoracic epidural analgesia, avoidance of fluid overloading, and laparoscopic-assisted surgery, have been shown to be effective in preventing postoperative ileus 1.

From the Research

Patients with Ileus and Oral Medications

• Patients with ileus may have difficulty taking oral (PO) medications due to the condition's effects on the gastrointestinal tract 2, 3.
• Ileus can cause delayed transit of gastrointestinal content, intolerance of food, and gas retention, which may impact the absorption of oral medications 3.
• However, some studies suggest that certain oral medications, such as selective opioid receptor inhibitors, can be effective in preventing or treating ileus without compromising analgesic efficacy 2, 4.
• The use of peripherally restricted oral antagonists, like alvimopan, may help speed recovery of bowel function and shorten hospitalization times while preserving the analgesic effects of opioids 2, 4.
• In patients with intestinal failure, including those with ileus, the absorption of oral medications may be affected due to reduced intestinal absorption of nutrients and/or water and electrolytes 5.
• Specialist pharmacists may be necessary to ensure that appropriate drugs and formulations are prescribed to optimize absorption and efficacy in patients with ileus or intestinal failure 5.